The reason it was the mantra back then was because there was always at least a few new people and people who were just kind of dull that simply didn’t get it and needed such a thing constantly repeated

I don’t think your post is bad or wrong. If I’ve worded my post ambiguously in a way that makes you feel attacked that was not my intention and I apologize; I do see how this could be the case re-reading it. I stream of consciousness post mainly. I intended to clarify your experience, which is why I started with the drawing of the spectrum and then in the second paragraph drew the argument without any specific citing of anything you said (but again re-reading this I can see how the ambiguity could read as inflammatory)

That said (and this is my opinion) I do not think your post should be changed; I generally do not think that any post should be changed so that the dialogue exchange can be preserved for others to see how things evolved. I believe there is a great deal of value in not just saying “this is the rule” but also exposing exchanges that clarify why “this is the rule” (though to be clear I don’t think this is a rule).

But I also believe that one should have autonomy over their content and that being the case if you choose to delete or edit your post I would support you exercising your autonomy even if i ultimately did not support the actions of changing your content. This inherently conflicts with the internet though as even sites like lemmy get archived plus I know some content on lemmy is publicly logged with things like moderator actions though I don’t know the extent of this. That’s just the nature of the internet in 2025 though. So much for “the right to be forgotten”, sigh

To clarify further on the reason it can be damaging is because it puts expectations on that population to be cheery and uplifting. Then when they are not they can be further ostracized for being “extra difficult” and “not one of the good ones”.

There were interesting social dynamics in those group homes. There were certainly a number of people who unfortunately had an intellectual impairment that was so severe they did not really register the other people around them in the typical social ways one would think. They would mainly consider in an immediate context and only form relationships with people who put in serious effort to engage and deliver positive feedback/rewards, which were almost always staff and not peers.

But then there were also plenty of people who had severe but not as drastic deficits. They would have much stronger social and communication skills but need much more assistance with things like safety awareness, activities of daily living, medical support, education and work supports, etc. this is where the aforementioned issues would come into play. Often the people who would be very personable and out in the community often would be trotted out for all kinds of things as a kind of marketing for the agency. They were a sign of the “great things” we did there.

Many of the people we worked with had unpredictable behavior that could become extremely dangerous, exhibited behaviors that were socially unacceptable like playing with feces or purposefully vomiting, etc. They didn’t get to go out as much and they didn’t get to be “the face”. To be clear we made efforts to take everyone out into the community as often as possible but some got special treatment. A place like that often gets donations and then “the special group” gets to go to a Major League Baseball game because a benefactor gave up their private box. Then everyone’s jealous because once again they’re left behind while the “good ones” come home with free stuff and tales of free chicken fingers.

In educational settings this came up too; I would consult and people would openly express disdain for special needs children who had high need because they weren’t like the other upbeat special needs kid that was easygoing. And this was crazy because it wasn’t just like a classmate bullying situation usually. Often that actually wasn’t happening anymore because the kid had scared the other kids. But now they’d be getting open disdain from educators and aides. Like I’d be observing in classrooms and the teacher would say something like “you see? I can’t handle this! No one can! This kid is impossible! He/she needs to be in a facility”. This isn’t like a “oh this happened one time, so crazy” thing, this kind of thing happened multiple times, multiple elementary schools. And frankly the teachers were partially right, basically every kid was inappropriate for public school and should have been placed out of school but that’s a different story about the snails pace of obtaining funding for alternative placements

Essentially this is a (very long, sorry) way of saying that this class of people is essentially invisible to the population at large and perpetuating this stereotype that they are cheery and nice means that the ones who don’t fit it are either hidden away or met with disdain (or outright aggression) because it is seen as abnormal.

Eh, it’s a spectrum like any other diagnosis (albeit a deprecated term). I’ve worked with intellectual and developmental disability for much of my career. I do more general outpatient now but the beginning of my career was almost solely ID/DD and I spent more time doing that than anything else in my career

I would argue it’s just as harmful to paint ID individuals as the “happy friendly” caricatures to sanitize them. They are dynamic and multifaceted. They have good and bad days, they are sometimes nice and sometimes mean. Some more than others. As a result some are just kind of jerks, frankly. And to be honest this is kind of fucked up but from my time working in inpatient residential I can tell you that it’s not unlikely that the people you encountered in the gym were on the “good temperament” side, or having a good stretch in their lives. Generally the people who were having a rougher time didn’t go out into the community as much, especially to a place as potentially dangerous as a gym

That said I truly don’t think Elon is intellectually disabled. I think he is possibly a sociopath who equates that to Asperger’s because he thinks it’s cool and mysterious since he’s emotionally stunted and stuck in his 14 year old edgelord phase for life, apparently. But I don’t know, never met the guy

Cobra is just the right to pay the employer portion of your health insurance after you leave your job so you don’t lose health insurance. Most americans skip it because they’re shocked to see just how much their employer subsidizes their health insurance

This is part of why there is such a push to decouple insurance from employment. Especially as corporations increasingly recognize they can both escape the tax demand of socialized health care and also escape the social contract of providing health insurance by moving more and more jobs to 1099/contractor positions

So remember when you are eyeing up that contractor job at amazon/doordash/uber/zocdoc/etc that is probably never going to unionize (if they have their say anyway): the 30-40k you earn there is really like 6-12k less (more if you want good insurance or support a family) because you will have to supply your own health/vision/dental (or you can just let yourself ignore all preventive care and/or keep your fingers crossed that you never have an inevitable health issue that will bankrupt you with your meager salary). Also keep in mind you get no retirement benefits. Good luck relying on social security/the national pension with musk and co continuing their assault on it. I don’t blame you if you take the job, we all gotta make ends meet, but try to get out asap because they will literally work you to death for a pittance

Yes, we’ve had socialized healthcare for ages. You just aren’t allowed to have it unless you’re old, very poor, disabled, or a vet. So they mean privatizing Medicare, Medicaid, and the VA

The secret is to just have a sticker area and then cover it in shit

That’s why the one wall in my little office nook is covered in anime characters and such

This is true and mental health is a pain in the ass specifically because of it.

This is probably what’s called an EAP, employee assistance program. Basically your employer benefits provider provisions a few sessions paid in full. Great for you, kind of a pain in the ass for me. It’s more paperwork, the coding is weird, and the payments are lower (sometimes by a lot, like 40% lower). Not your fault at all obviously and entirely an insurance problem. Just another thing that makes working within this system an absolute nightmare.

However, sometimes this is called a “carve out”. This is different and less of a direct pain but causes so much confusion. This is where your works benefits provider decides that insurance company a charges too much for mental health coverage so they don’t purchase that portion and instead “carve it out” and replace it with insurance company b. This can result in you having specific copays for mental health even if you have high deductible (or even a separate deductible) because it’s essentially a secondary insurance (though technically it’s not considered as such and you would generally never even know the name of the company handling the carve out)

This is SUPER confusing for consumers because when you get your benefits package they hand you a card that says Aetna or Cigna or whatever. Then you see my psychologytoday profile and I advertise I’m in network with Aetna, Cigna, etc. great! we do a consultation, feels good, you send me your info, then I go “ooh, so sorry, turns out I don’t take your specific Aetna plan”. Because your Aetna plan takes mental health coverage and subcontracts it to another company who I have never paneled with.

Sometimes this is because I have never even heard of the company (paneling with an insurance co is weird, sometimes it takes a week, sometimes it takes 10 months), sometimes it’s because their reimbursement rates are a joke (one literally pays $24/hr which doesn’t even cover my overheads), etc. This isn’t entirely on the insurer though as it’s the employer that cuts coverage benefits to do this, although the insurer rising costs year after year is definitely a factor in why an employer would do that tbf

Those people generally have really good insurance

That’s one of the key issues of tying health insurance to employment: it creates a backwards system where the affluent pay basically nothing for care and those who make little pay a great deal

There’s a weird curve at the bottom because of government services like Medicaid, with these you also pay very little to nothing, but in most states you have to basically be destitute to qualify

It’s one of the most frustrating things about being someone who takes insurance as a career. The people I see who make $30-40k or less? They have 4-10,000 deductibles and pay 10-30% coinsurance after, on top of hundreds of dollars of premiums coming out of their check (that percentage wise take up a huge chunk of each pay). Their out of pocket max is also very high so their medical spending has to be pretty crazy to get to the point where they just don’t have to pay anymore

But the people who make 100k? 150? 200+? They almost always have nice PPOs. They pay $5-30 per visit. They have lower out of pocket max (though tbf still fairly high, it’s insurance) so their copays can go away (but this is uncommon, tbf). They pay more out of their check but not as much as you’d think because it’s usually more heavily subsidized by their employer (“nicer benefits for essential staff”) and given their substantially higher income it’s often much less percentage wise of their net earnings.

So someone says “go see a therapist”. If you’re making 40k a year with avg benefits that might mean you’re now on the hook for $120 a week for weeks or months (or more!) because of your high deductible plan, until you finally hit that deductible. If you’re young and healthy and don’t utilize much you may never hit it just going to therapy. Even if you do you’re still on the hook for 12-36 dollars a meeting after that. Meanwhile the 150k a year tech bro or banker goes and pays $10 a week.

It’s not always like this of course. Sometimes low earners get bad PPOs with high copays that feel criminal ($75 per meeting). Sometimes high earners do high deductible plans because they realize the accounting makes more sense for their medical spending. Or sometimes they work for a company that cheaps out on benefits even though it pays a few people very lucrative salaries. Etc

But it’s also one of the hard issues to solve as a result. In an ideal world the people who have more resources would pay more and the people who have less would pay less. The sliding scale payment system where the wealthy subsidize those who have less. But people are greedy and don’t want to give away their money. And guess who has more political power and also tends to vote more?

Bleed in my ass

those bass drum hertas tho

I am a therapist. I take insurance but it’s a goddamn nightmare

You either join a group practice (goodbye at least 40% of earnings) or you try to go it alone

If you go it alone: hello navigating the maze of bureaucracy that is insurance credentialing and billing. Good luck! No real guidance here. There are some “tutorials” online but they’re super generalized because everything is very different on a regional level. Aetna in Atlanta is entirely different from Aetna in New Jersey. Then you can also play the game of “guess how much money I will make?” Because none of them tell you until you’re about to sign the contract (and some don’t tell you until after!). Or you can pay someone to do all this for you for like $1000. Also it takes months. Then you have to figure it all out again to figure out how to bill. Then you have to figure it all out again to figure out how to bill electronically because you bill on paper the first few times to get payments and then use the payment numbers to set up accounts to actually bill the normal way. Or again you can pay someone to bill for you for like 5-10% of your earnings.

And all of this is while you’re a 1099 worker so no health insurance, paid time off, retirement, etc

Alternatively you can in some places join a hospital system. These will sometimes pay you a salary and benefits but will usually pay a shit salary, crappy benefits, and give you a nightmare quota and ask you to supervise interns. Or work someplace like an IOP and run groups but again you’ll make like 40-50k tops with crappy benefits (and the student loan debt of someone with a masters degree). Plus a lot of those places will still keep you as a 1099, at least around here.

So then the community mental health/medicaid agencies cry about why they can’t keep staff and the mental health crisis facing low ses communities (hint: it’s because you pay $30/hr as contract workers to people with 100k+ student loan debt)

Then people run from those places to group practices and stay there for a bit but eventually bail because they take 40% of earnings

Then they go independent and panel with insurers and it’s okay but also a fucking headache. They work 25 hours a week seeing clients and 15 hours a week unpaid doing paperwork to bill for said clients. All well and good except what the article wrote is all true, eventually you get a clawback where an insurance company is like “you wrote 90847 and you meant 90837, you could just correct and resubmit but we won’t allow that. You did it 15 times so we are demanding you return $8,000 thanks” also your quarterly tax payment is due tomorrow. Oh and your insurance billing has to be submitted timely but Aetna is 3 months late in paying you and owes you 6k. It will come, eventually, probably

Also all that admin stuff they refuse to pay you to do? They pay grow and headway and alma and all those other vc backed tech bro companies that started during Covid to “revolutionize mental health” lmao. They pay them $30-40 a session to do it. Shoulda made a website milking off other therapists with a sob story about how you were depressed and had trouble finding a therapist bro, you could’ve been a multimillionaire instead of some dipshit making 65k with no retirement savings

Medium rare? Wuss.

https://www.chefsteps.com/activities/chicken-tartare